BackgroundRisk factors of refracture after fragility fractures include osteoporosis, female gender and advanced age among others. We hypothesized that the assessment of functionality, muscle health and nutrition status contribute to the risk prediction for further fractures and death.MethodsWe assessed 334 patients admitted to the department of acute geriatrics for sociodemographic data, bone fragility, selected laboratory tests, body composition and data on functionality using the comprehensive geriatric assessment. Patients had follow‐ups until the occurrence of further fractures or death. Dual‐energy X‐ray absorptiometry and pulse echo measurements were performed to assess bone mineral density. Fracture risk was assessed using the FRAX score and muscle strength according to published guidelines on sarcopenia.ResultsThe mean age was 81 years (70–95), and 82.3% (275/334) were women. An incidence of 10.4% (35/334) new fragility fractures was observed within 24 months, and the mortality rate was 12.2% (41/334). A significantly higher rate of further fractures was associated with lower BMI (body mass index) (HR 0.925, CI 0.872–0.98; p = 0.009), lower parathyroid hormone levels (HR 0.986, CI 0.973–0.998; p = 0.026) and with the diagnosis of osteoporosis (HR 2.546, CI 1.192–5.438; p = 0.016). No significant associations were present in patients with previous fractures, with higher age, higher FRAX scores, sarcopenia, in women, sarcopenic obesity, frail patients, lower grip strength, lower walking speed, lower Barthel index or lower DI (density index) values. The predictive power for further fractures was 10.7% higher adding osteosarcopenia, BMI and parathyroid hormone levels to standard assessment parameters osteoporosis, age and the status of previous fractures. Mortality was significantly higher with advanced age (HR 1.101, CI 1.052–1.151; p < 0.001), in men (HR 6.464, CI 3.141–13.305; p < 0.001), in smokers (p = 0.002), higher FRAX score (HR 1.039, CI 1.009–1.070; p = 0.010), lower renal function (HR 0.987, CI 0.976–0.997; p = 0.010), lower Tinetti test scores (HR 0.943, CI 0.900–0.987; p = 0.012), lower walking speed (HR 0.084, CI 0.018–0.382; p = 0.001), lower hand grip (HR 0.876, CI 0.836–0.919; p < 0.001) and lower Barthel index scores (HR 0.984, CI 0.971–0.997; p = 0.015).ConclusionsIn a cohort of geriatric patients, the addition of BMI, low parathyroid hormone levels and osteosarcopenia increases the predictive power for further fractures by 10.7%. These parameters are a valuable addition to the standard assessment parameters age and history of sustained fractures. Mortality is partly associated with potentially treatable functional parameters.

中文翻译：

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老年患者队列脆性骨折和死亡率的预测


背景脆性骨折后再骨折的危险因素包括骨质疏松症、女性和高龄等。我们假设功能、肌肉健康和营养状况的评估有助于进一步骨折和死亡的风险预测。方法我们使用综合老年病学评估评估了 334 名急性老年病科收治的患者的社会人口学数据、骨骼脆性、选定的实验室检查、身体成分和功能数据。患者接受随访，直至发生进一步骨折或死亡。进行双能 X 射线吸收测定法和脉冲回波测量以评估骨密度。根据已发布的肌肉减少症指南，使用 FRAX 评分和肌肉力量评估骨折风险。结果平均年龄为 81 岁 （70-95），其中 82.3% （275/334） 为女性。24 个月内观察到 10.4% （35/334） 的新脆性骨折发生率，死亡率为 12.2% （41/334）。进一步骨折的发生率显著升高与较低的 BMI（体重指数）（HR 0.925，CI 0.872-0.98;p = 0.009）、较低的甲状旁腺激素水平（HR 0.986，CI 0.973-0.998;p = 0.026）和骨质疏松症的诊断（HR 2.546，CI 1.192-5.438;p = 0.016）相关。既往骨折患者与年龄较高、FRAX 评分较高、肌肉减少症、女性肌肉减少症、肌肉减少性肥胖、虚弱患者、握力较低、步行速度较低、Barthel 指数较低或 DI （密度指数） 值较低。将骨肌肉减少症、BMI 和甲状旁腺激素水平添加到标准评估参数骨质疏松症、年龄和既往骨折状态中，对进一步骨折的预测能力高出 10.7%。 死亡率显著高于高龄（HR 1.101，CI 1.052-1.151;p < 0.001）、男性（HR 6.464，CI 3.141-13.305;p < 0.001）、吸烟者（p = 0.002）、较高的 FRAX 评分（HR 1.039，CI 1.009-1.070;p = 0.010）、较低的肾功能（HR 0.987，CI 0.976-0.997;p = 0.010）、较低的 Tinetti 测试评分（HR 0.943，CI 0.900-0.987;p = 0.012）、 较低的步行速度 （HR 0.084， CI 0.018–0.382;p = 0.001）， 较低的手握力 （HR 0.876， CI 0.836–0.919;p < 0.001） 和较低的 Barthel 指数评分 （HR 0.984， CI 0.971–0.997;p = 0.015）。结论在一组老年患者中，增加 BMI 、低甲状旁腺激素水平和骨肌肉减少症使进一步骨折的预测能力增加 10.7%。这些参数是对标准评估参数、年龄和持续性骨折病史的宝贵补充。死亡率部分与可能可治疗的功能参数相关。